Locum Work – Taking the Leap and Defying Gravity

My occupational therapy journey so far has felt like a rollercoaster. It all started with the first ascent into acute inpatient mental health. After a year, I finally felt that the journey had smoothed out. Then came the next big hill – working in eating disorders, followed by another hill as I was promoted to senior occupational therapist and embraced more service development and leadership opportunities.

I truly love working in eating disorders. Although there is a predictable structure to the week, every day holds something different; a perfect combination for someone like me who enjoys structure yet craves stimulation and challenge. My rollercoaster ride has been enriched by each person I have worked with; fascinating, inspirational people who have all brought their own unique struggles and personal qualities to the journey. And I am a better occupational therapist – and person – as a result of knowing them.

My favourite thing about this role (which is advertised on the NHS Jobs website) is that it has given me a precious opportunity to practice in a way that is consistent with my personal and professional values. Step Up is a unique occupational therapy-led service built on the foundations of collaborative working, occupation-focused practice and constant development .

And yet, the time has come for a completely new rollercoaster experience. I’m leaving permanent employment to become a locum (or temporary) occupational therapist. This is an exciting new opportunity for my rollercoaster to connect to new tracks, where I hope to develop new skills and ideas to keep me hurtling forward.

There’s a rollercoaster – the Gravity Max in Taiwan’s Discovery World theme park – which perfectly exemplifies this stage in my occupational therapy journey. On this ’tilt coaster’, the track ahead of you only connects moments before you drop.

And so, as I travel along the final stretch in my current role, staring at the abruptly ending track and wondering what lies ahead, I feel a mixture of sadness, excitement, panic and hope. Just as you do on a rollercoaster, I am embracing the confusing mix of emotions and doing all I can to remain fully present in the moment. In the words of one of my favourite songs from a musical:

“Too late for second-guessing

Too late to go back to sleep

It’s time to trust my instincts

Close my eyes

And leap

It’s time to try defying gravity”

If you are also considering Defying Gravity, contact me on LinkedIn. I’ve learnt that the journey is far more enjoyable (and way less terrifying!) when you’ve got someone in the seat next to you. I may be able to recommend an agency or share some of the knowledge I hope to pick up.

Or, at the very least, I’ll be someone to scream in the seat next to you!

Advertisements

The 18-Month Roller-Coaster Ride: An Update

It’s been over six months since I wrote the last blog post about my transition from student to newly qualified occupational therapist. As I questioned whether I had enough to say to warrant another post, a realisation hit me:

I no longer feel “newly qualified”.

Of course, I still have a lot to learn, but university feels like a distant memory. I definitely feel like a “Real OT” now.

Someone commented on my original post, Becoming a “Real OT” – The Roller-Coaster Ride, saying that

… Every time there’s a new stretch, we’re back on the roller coaster again… fasten your belts and hold tight, but most of all, enjoy the ride… – Cathy

She was right. Working in a specialist eating disorders service has brought many steep learning curves, and I have often felt very incompetent, overwhelmed by my development needs. But what’s reassuring is that the roller-coaster ride seems to have smoothed out more quickly this time.

Dreamland Margate
photo by ArtistianDavid (Flickr)

I’ve wondered what changed, to make me feel like a “Real OT”. And the simple answer is probably “experience”. The more I encounter similar situations, the better I’m able to anticipate issues that might crop up and prepare for them. As a result, I feel more proactive and resilient. The more experience I gain, the more my skills and confidence develop too.

Revisiting Bassett and Lloyd’s (2001) and Ashby et al.’s (2013) articles, I’m aware of two things that have been particularly helpful in coping with the highs and lows of the roller-coaster ride:

  • Recognising stress – perhaps part of what has made the ride feel more manageable has been an improvement in my ability to recognise and manage my own stress. My favourite strategies have probably been relaxing in the hydropool/sauna at the gym, becoming absorbed in exploring my local area (rather than holding on to stress outside of work), and using the support available to me, both at work and in my personal life. Fortunately, my team are very aware of the stressful nature of the job (each shift, we’re asked to rate our stress levels using a traffic light system), and I have regular supervision with an occupational therapist, alongside team supervision and a staff support group.
  • Using occupation-focused models and terminology – my role was initially very generic, and I’ve noticed a significant difference as my practice has become increasingly occupation-focused. Feeling like an authentic occupational therapist with a unique contribution has increased my confidence and job satisfaction.

Now I’m enjoying the ride, and I can’t wait to see what’s around the next bend!

 

References:

Ashby, S.E., Ryan, S., Gray, M. and James, C. (2013) ‘Factors that influence the professional resilience of occupational therapists in mental health practice’, Australian Occupational Therapy Journal, 60, pp. 110-119, DOI: 10.1111/1440-1630.12012 (Accessed: 9th March 2014)

Bassett, H. and Lloyd, C. (2001) ‘Occupational Therapy in Mental Health: Managing Stress and Burnout’, British Journal of Occupational Therapy, 64(8), pp. 406-411 (Accessed: 4th January 2012)

 

Previous posts:

Being a Third Culture Kid: A River of Transition

Here is the link to the recording of my presentation for this year’s Occupational Therapy 24-our Virtual Exchange (#otvx13): ‘Being a Third Culture Kid: A River of Transition’, which I presented virtually, in my onesie on 26th October 2013. The abstract is available on the OT4OT site. My presentation starts about halfway through, following Kerstin Gadsten’s powerful presentation about shedding a disability label.

If you’re having trouble with the link above (a lot of people are), try this link, and with a different browser

I’ve also uploaded my slides to SlideShare (we had an upload error on the day), which can be viewed below.

References

Bell-Villada, G.H. and Sichel, N. (2011) ‘Introduction’ in Bell-Villada, G.H., Sichel, N., Eidse, F. and Orr, E.N. (eds) Writing Out of Limbo: International Childhoods, Global Nomads and Third Culture Kids. Newcastle Upon Tyne: Cambridge Scholars Publishing. pp. 1-16

Cockburn, L. (2002) ‘Children and Young People Living in Changing Worlds: The Process of Assessing and Understanding the Third Culture Kid’, School Psychology International, 23(4), pp.475-485

Cottrell, A.B. (2002) ‘Educational and Occupational Choices of American Adult Third Culture Kids’ in Ender, M.G. (ed) Military Brats and Other Global Nomads: Growing Up in Organization Families. Westport: Praeger Publishers. pp. 229-253

Linderman, P. (2011) ‘Lemonade for the Gringa: Advice For and From Teenaged Global Nomads’ in Bell-Villada, G.H., Sichel, N., Eidse, F. and Orr, E.N. (eds) Writing Out of Limbo: International Childhoods, Global Nomads and Third Culture Kids. Newcastle Upon Tyne: Cambridge Scholars Publishing. pp. 210-219

Pollock, D.C. and van Reken, R.E. (2009) Third Culture Kids: Growing Up Among Worlds. London: Nicholas Brealey Publishing

Van Reken, R.E. (2011) ‘Cross-Cultural Kids: the New Prototype’ in Bell-Villada, G.H., Sichel, N., Eidse, F. and Orr, E.N. (eds) Writing Out of Limbo: International Childhoods, Global Nomads and Third Culture Kids. Newcastle Upon Tyne: Cambridge Scholars Publishing. pp. 25-44

Walters, K.A. and Auton-Cuff, F.P. (2009) ‘A Story to Tell: the Identity Development of Women Growing Up as Third Culture Kids’, Mental Health, Religion and Culture, 12(7), pp. 755-772

Wu, A.S. (2011) ‘Global Nomads: Cultural Bridges for the Future’ in Bell-Villada, G.H., Sichel, N., Eidse, F. and Orr, E.N. (eds) Writing Out of Limbo: International Childhoods, Global Nomads and Third Culture Kids. Newcastle Upon Tyne: Cambridge Scholars Publishing. pp. 332-353

Announcement: #ot24vx Presentation

The schedule for this year’s 24 hour virtual exchange has been published. This year’s topic is ‘Transition’, and I’m very excited to (finally) be able to tell you all:

I’m going to presenting this year on my experience of being a(n adult) third culture kid.

A Third Culture Kid (TCK) is a person who has spent a significant part of his or her developmental years outside the parents’ culture. The TCK frequently builds relationships to all of the cultures, without having full ownership of any.

Pollock and Van Reken (2009) pg. 13

I will be sharing elements of my narrative, using the metaphor of a river (kawa) – expect embarassing photos! But, being the geek that I am, I will also be incorporating bits of theory and research.

I’ve been writing a blog post on the topic, and hope to have it finished in time (this may depend on how hectic this current life transition of moving house/city and starting a new job is).

This event will be a first for me in many ways:

  • My first time presenting at an international conference.
  • My first time presenting at a virtual conference.
  • And, possibly most importantly: My first time speaking publicly in a onesie.
IMG_3940
Photo Credit: ElysiaP (Flickr)

I hope to see you all there! (It’s virtual, and on a Saturday)

The Roller-Coaster Continues: from Acute to Eating Disorders

This week marks the end of my first year as an occupational therapist, and with it, the end of my first (temporary) post. I’ve enjoyed working in adult acute inpatient mental health, particularly the flexibility that the role affords. Being ward-based has allowed me to work very closely with the multidisciplinary team, constantly re-evaluating my practice in the face of changing service user and service needs. I’ve had a lot of freedom in developing my role on the ward, and have had many opportunities to build on my interests.


Working with hundreds of people with varied, “complex and intractable presentations” (Brennan, 2008, pg. 39) has taught me a lot. As I compare my current performance with that on my elective placement (also acute inpatient), I’m aware of how much my skills and confidence have grown over the past year. I remember realising early on in my post that I had completed more initial assessments in one week than I had during the entire three years of university. On a daily basis, I prioritise, develop relationships, assess, facilitate group/individual interventions, de-escalate/contain, and contribute to multidisciplinary decisions. I’ve focused on developing skills in risk management, collaborative assessment/care planning, and therapeutic use of self (including Cognitive Analytic Therapy skills). I have also begun to learn about trauma-informed practice, an area I would like to develop further.


Comparing these final months to when I first started, I realise that the roller-coaster ride of becoming an occupational therapist has smoothed out significantly. For one, work uses far less energy than it did at the start (which is a relief!). Now that I’m moving to a new clinical specialty – eating disorders – I feel like I’ve re-joined the queue for the roller-coaster. I have a short period of rest before choosing to get back on the ride. While I anticipate that the roller-coaster will pick up speed again and take me on dizzying new loops, I feel better prepared this time. I have some idea of what to expect, and have more experience to draw on. And there’s no turning back now!


Processing
Photo Credit: craigallen (Flickr)

Occupational Therapy Interviews

This time last year, I breathed a huge sigh of relief as I turned off my NHS Jobs e-mail subscription. I accepted a fixed term post and quickly put the temporary nature of the job out of my mind. However, 9 months later, I turned the e-mail alerts back on as my contract neared its end. And all the uncertainty and anxiety involved in the job application process suddenly came flooding back. (I have been fortunate to secure another occupational therapy post relatively quickly – more about that another time, maybe).

All my interviews have been for mental health posts, and each interview has varied quite significantly in terms of questions. But – as I’ve recently noticed a lot of questions in Facebook groups about OT interviews (particularly about tests, group interviews, and question formats) – this seemed like the right time to share my recent experiences.

Job Applications

Universities have no doubt spent lots of time preparing students for job applications, so I’ll keep this part brief. Probably the most valuable advice I was given was:

  • Tailor your application to the person specification and organisation that you are applying to. (It sounds obvious, but is easier said than done if you’re short of time!) This includes writing a paragraph about why you have applied for this particular job in this particular organisation.
  • Submit your application as quickly as possible, but take the time to proofread. Many adverts close as soon as they’ve received a certain number of applications – and this could be in as little as a couple days, depending on the post.

Preparation

It’s no secret that I’m very organised. Preparation for interviews is no exception – although I had far less time available for preparation when working. One week, I had three interviews in different parts of the country, which left me with little time/energy to prepare.

My “system” is as follows: I create a little file for each interview. I print out the person specification, and go through each item, preparing examples or looking up relevant information. For each, I  also prepare a “why I want to work for this organisation, and why should you hire me” sheet. I put all my notes in the file with the person spec, and take it with me on the train to look through while I’m traveling. Fortunately, many person specifications cover similar topics, so I’m able to reuse much of the preparation.

However, I have a rule to never prepare on the day of the interview. Someone once told me that preparing for a test/interview on the day is ineffective because it raises your anxiety levels, and any new information stored in your short term (rather than long term) memory. Instead, I use my time to manage my pre-interview nerves, e.g. through breathing exercises, listening to music and going for a walk.

Individual Interviews

Most of the interviews I was invited to were individual interviews. The interview panels were usually made up of at least one occupational therapist, along with other professionals (nurses/psychologists) and service users.

At each interview, I was asked why I applied for the job and what skills/qualities I would bring to the post that would set me apart from other candidates, so I would highly recommend preparing for this question. Other questions were generally scenario-based and covered topics like:

  • OT Core Skills/Role (e.g. “What are the core skills of an occupational therapist?”, “What unique contribution could an occupational therapist make to this team?”, “What do you understand the OT role to be in this setting?”, “A carer phones you. They ask what occupational therapy is and what you can do for their loved one. What do you say?”, “What are the components of effective occupational therapy? Please give an example of a time when you delivered effective OT”)
  • Group Work (e.g. “Describe what you would need to consider before running a [Smoothie] group, and what you would be able to assess within this group?”, “Tell me about a successful group intervention you used. How did you know that it was successful, and what theory/evidence informed the intervention?”)
  • Assessment (e.g. “Tell me about a standardised assessment you’ve used”)
  • Risk management (e.g. “You’re running a group and notice that a pair of scissors has gone missing. What do you do?”, “Tell me about a situation where you managed risk effectively”)
  • Therapeutic use of self (e.g. “How would you begin to develop a relationship with a service user who presents with bizarre and destructive behaviour?”, “How would you know if someone was distressed, and what would you do?”, “How would you respond to someone who was verbally hostile towards you?”, “A service user discloses abuse to you. How do you respond?”)
  • Continuing professional development (e.g. “We value reflection in our team. Can you tell us about how you use reflection in your practice?”)

In posts that were condition-specific (e.g. personality disorder or eating disorder posts), I was asked what I knew about the condition. The first time I was asked this question, it completely threw me. I didn’t know where to start! However I learned my lesson for the next interview, and prepared an answer that demonstrated my understanding of the condition and how it can impact on occupational performance. I was also asked what the challenges are of working with particular client groups.

I was also asked more general/stereotypical interview questions, e.g. “where do you see yourself in five years’ time?”, “what are your strengths and weaknesses?”, “what do you know about this organisation”. And of course, each interview ended “Have you got any questions for us?”.

Presentations

A couple interviews asked me to prepare a 10 minute presentation on a particular topic. I arrived at one interview to be told that they were having technical problems with the computer. Fortunately, I had printed handouts with my slides (have I mentioned that I’m ever so slightly organised?) and was able to use these to support my presentation. Another interview explicitly stated that we were to present without slides.

Tests

I’ve only had to do one test during an interview, and it wasn’t nearly as bad as I had expected! The questions were the same type of questions that I had been asked at other interviews. The difference was that the questions had to be answered in writing, and that I had to work out how to use the limited time available to answer all the questions (about 8 questions in 20 minutes).

I think it’s worth mentioning that if you have dyslexia, you can request additional time to complete written tests, but you need to do this when you confirm your interview.

Group Interviews

I’ve had two group interviews, and was especially nervous about them because I didn’t know what to expect. Most people were friendly and supportive, and I enjoyed their company.

In both interviews, we were asked to plan a presentation on a particular topic – again, scenario based – and then present it back to the interview panel. We were observed throughout.

In one interview, each person was ‘guaranteed’ an individual interview, and the first question of the individual interview was about our reflections on the group dynamics and our performance within the group. In the other, the group interview was a filter system and only a certain number of people got individual interviews based on their performance.

Surprisingly, I found the group interviews helped with nerves as, once we got talking, I became focused on the conversation/task.

CPD Portfolio

Finally, the Epic CPD Portfolio. I took my portfolio with me to each interview. Most did not ask to see it, but I used pieces of evidence to back up what I was saying (for example, in the “give me an example of a time when you…” questions, I would find a reflection on the relevant situation/skill. It was also very useful evidence in the “tell me about how you reflect” question!). However, in one interview, the panel asked to see my portfolio and looked through it from front to back. They asked questions about different pieces of evidence/reflection, and commented on the way that it was presented. So it’s definitely worth investing a bit of time in your CPD portfolio and making sure that you’re familiar with the layout, so you can access relevant evidence easily.

I would recommend checking out the OT New Graduates Facebook page. It’s a great place to find out about other people’s experiences of interviews, and to ask specific questions. Emerging2OT is another group that I’d recommend as a place to talk about the transition and just generally about interesting OT-related things.

Also, @OTtwehy will be hosting an #OTalk (twitter chat) about interviews on Tuesday 29th October 8pm (UK time) and all are welcome to attend! The transcript of this chat can be found here.

Emerging 2 OT: The Journey So Far

I was very fortunate to have the opportunity to share my experiences at the Emerging 2 OT student conference, organised by Michelle Perryman (@Symbolic_Life) and her fantastic team. Live tweets from the day have been compiled in a GrabChat, and analytics are available on Symplur for those ultra-geeks out there (it’s okay, you can click the link, I count myself in this category).

644275_10151392915305197_1784257792_n

Hazel Clerkin and I facilitated three workshops about the transition from student to newly qualified practitioner within the National Health Service. The Prezi can be viewed at this link. We drew on the Kawa Model and a Coping Tree as visual representations of the challenges and strategies we experienced during our transitions. Workshop participants were invited to create their own, and the result was this shared expression of expectations of the transition’s challenges (leaves) and coping strategies/resources (butterflies):

484739_10151465798885197_1690772883_n

Having received a few requests for ideas about how to structure continuing professional development portfolios, I decided to brave it and bring my own for delegates to look at. Below is a photo of my portfolio which is based on the Knowledge and Skills Framework and the College of Occupational Therapists Preceptorship Handbook. People were particularly interested in the visual reflections, and I hope to write more about this in the future.

P1110296

Unfortunately, I wasn’t able to attend any of the other sessions, but judging from the atmosphere and live tweets, they were informative and thought-provoking. @pd2ot’s blog post gives a flavour of what the day was like. (If anyone else has blogged about it or has a reflection they would like to share, please let me know!)

Becoming a “Real OT” – the Roller-Coaster Ride

As a student, I often said “I can’t wait to be a real OT”. At the start of April, I will have been in my first occupational therapy post for six months. So does this mean I am now “real”?

My transition from student to practitioner has been exciting and squee-inducing, but it has also had its challenges. As I prepare for my six-month review, which coincides with #OTalk on Tuesday 2nd April (‘The Transition to Newly Qualified OT’), I realise what a Roller-Coaster Ride the last few months have been.

Roller Coaster
Photo Credit: McCory James (Flickr)

The First Hill

For me, the most uncomfortable part of a roller-coaster ride is the first ascent: being slowly pulled towards the unknown – never fully confident that the anti-rollback device will hold – and realising that I no longer have the option of changing my mind. Of course, the discomfort I feel at this stage is mixed with excitement, and hope that the thrill will be worth the time spent queuing. In many ways, this mirrors the anticipation of waiting to start my new post. Tryssenaar and Perkins (2001) describe this stage as one where a “thread of concern” is “woven within the eager anticipation” (p. 22). Waiting for pre-employment checks to come through felt like an eternity. I was so excited to “finally be A Real OT”. But as I slowly neared my start date, I began to wonder whether the three-year “queue” had sufficiently prepared me for the challenge.

The First Drop

The strongest memory I have of roller-coasters is the first drop – feeling so bewildered by my apparent inability to scream that it takes a few moments to notice what is happening in my environment. My first weeks in post were overwhelming. I had suddenly gone from being a skilled student to being a novice practitioner. I experienced a lot of self-doubt and struggled to balance my own expectations with the reality of practice. As a student, I had been used to having an educator to observe. Not having another occupational therapist on the ward left me with a lot of uncertainty about what “good enough” looked like. I compared myself with the senior occupational therapists on my elective placement – and was not measuring up.

Enjoying the Ride

Somewhere along the way, the ride has smoothed out. I feel more confident and in control of the direction of the ride. I am enjoying “the routine of clinical practice… one of discovery and learning from clients and testing out one’s own clinical judgment” (Rogers, 1987, cited in Tryssenaar and Perkins, 2001, p. 20). I’ve also realised that I’m not alone: I have a whole team of people in the car with me.

Air-Time

Every now and then, something happens that makes me feel exhilarated and almost weightless – like those moments on a roller-coaster where it feels like your body is leaving the seat or your stomach has dropped through the floor. More and more, I am experiencing pride in my work, and recognising my achievements (rather than feeling almost guilty that my patients are “stuck with” me instead of a more experienced or skilled occupational therapist).

The Climb

However, I continue to face steep learning curves. Each time I reach the top of a hill, I realise how much further I have to go. I have to continually remind myself to experience the ride moment by moment, rather than allow myself to become overwhelmed by the enormity of the full circuit.

Safety Mechanisms/Restraints

  • Preceptorship – I have been fortunate to work in a setting that supports preceptorship  (a structured transition period). Although I initially found it frustrating to focus on pre-set objectives rather than my own priorities for development, I have come to appreciate this structure as a “break” system, slowing me down and ensuring that my development is balanced.
  • Preceptorship Peer Support – Meeting every few weeks with my newly qualified nursing colleagues has normalised my experiences. Through honest and open discussions, I have realised that others share my insecurities and frustrations. This is consistent with the experience of Smith and Pilling’s (2007) participants: “realising that feelings of inadequacy and uncertainty were common was reassuring for participants. Group discussions of feelings and experiences were reported to decrease emotional isolation…” (p. 271).
  • Reflection – I have heavily utilised reflection as a way of coping with reduced support and supervision. As a student, I rarely wrote reflections (as I favoured “doing it in my head”). But I have realised that by writing my reflections down in a structured way, I not only focus better and reflect more deeply, but I also provide ongoing evidence for my preceptorship/Knowledge and Skills Framework. Continuing Professional Development has become “a vehicle for professional socialisation” (McKinstry et al, 2009, p. 141) and a way for me to independently monitor my development and competence.
  • Personal Learning Network – My personal learning network has been an invaluable source of personal and professional support. I am fortunate to know many wonderful people who have been there to provide a safe space for processing, support my reflection, re-ignite my interest or just give me a hug.

A Note on Energy

Like a roller-coaster, I only have a limited amount of energy available to complete the circuit. I remember feeling completely exhausted after placements, having spent my evenings and weekends reading and preparing. I knew this wouldn’t be sustainable in the longer term. Since starting my post, I have been strict with myself about leaving work on time, taking my breaks, and not using my personal time to prepare. I have missed having “study days” and will admit that I continue to use my own time for continuing professional development.

I have had to make a real effort to “practice what I preach” with regards to self care and occupational balance. Arguably, as occupational therapists, we are at an advantage as we have experience of teaching our clients to use these skills (Cox, 1988, cited in Bassett and Lloyd, 2001). However, the pursuit of balance still requires honesty, reflection and active choices (Clouston, 2011) and is an ongoing challenge.

We will be discussing the transition from student to practitioner on Tuesday 2nd April, 8pm GMT using the #OTalk hashtag on Twitter. I look forward to hearing about other peoples’ experiences or expectations of the transition from student to practitioner.

Here is a link to a transcript of the #OTalk discussion about the transition from student to practitioner (opens in new window).

References

  • Bassett, H. and Lloyd, C. (2001) ‘Occupational Therapy in Mental Health: Managing Stress and Burnout’, British Journal of Occupational Therapy, 64(8), pp. 406-411 (Accessed: 4 January 2012)
  • Clouston, T. (2011) ‘Worked Out and Still Wanting: Finding Balance in Busy Lives‘ presentation, Occupational Science: OTs Owning Occupation Conference, 8 September, University of Plymouth, UK.
  • McKinstry, C., Allen, R., Courtney, M. and Oke, L. (2009) ‘Why Occupational Therapy Needs Evidence of Participation in Continuing Professional Development’, Australian Occupational Therapy Journal, 56, pp. 140-143 (Accessed: 11 March 2012)
  • Smith, R.A. and Pilling, S. (2007) ‘Allied Health Graduate Program – Supporting the Transition from Student to Professional in an Interdisciplinary Program’, Journal of Interprofessional Care, 21(3), pp. 265-276 (Accessed: 4 January 2012)
  • Tryssenaar, J. and Perkins, J. (2001) ‘From Student to Therapist: Exploring the First Year of Practice‘, American Journal of Occupational Therapy, 55, pp. 19-27 (Accessed: 4 January 2012)